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Clinical Research in Dermatology: Open Access
Case Report
Open Access
Taekwondo Nails: A Case Report and Review of the
Literature on Sport-Related Nail Abnormalities
Isabel Cristina Valente Duarte de Sousa1*, Antonella Tosti2
1
Department of Dermatology, México city, México
Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
2
Received: April 29, 2016; Accepted: May 30, 2016; Published: July 01, 2016
*Corresponding author: Isabel Cristina Valente Duarte de Sousa: Department of Dermatology, Private practice, México city, México. E-mail:
[email protected]
Abstract
Nail abnormalities related to different sports have been described
in the literature. In this article, we report the case of a male patient
with nail abnormalities due to taekwondo and review the literature
for sport specific nail changes. To our knowledge, this is the first
article that describes nail abnormalities associated with taekwondo.
Keywords: Nail Dystrophy; Traumatic Nail Dystrophy; Nails
and Sports; Taekwondo Nails; Onychodystrophy; Sport Related Nail
Changes
and shortening of the nail plate with superficial scaling (Figure
2).
A diagnosis of nail matrix damage due to Taekwondo was
made and the patient was instructed to avoid backhand punches
during practice.
Introduction
Sport related abnormalities of the nails are frequent because
the nail plate, nail bed, nail matrix and periungual area experience
significant amounts of pressure and trauma during these athletic
activities [1-3].
Since the type of trauma differs with each sport, the nail
changes are sometimes sport specific [1]. Toenails are more
commonly affected in sports such as tennis, soccer, basketball,
running, golf, gymnastics and dancing [1-4] while the fingernails
are affected in karate, judo, golf and Frisbee [3,8,9,10].
Figure 1: Second Finger of Right Hand with Onichorrhexis and Brittleness.
We describe the case of a male patient with nail abnormalities
due to taekwondo and review the literature for sport specific nail
changes. To our knowledge, this is the first article that describes
nail abnormalities associated with taekwondo.
Case Report
A 38-year-old male patient had a 1-year history of nail
dystrophy, thinning and cracking of the right index finger. He had
no relevant past medical history. He denied any acute trauma
to the nail and hands, but with direct questioning said that he
practiced Taekwondo. He mentioned that during practice he
performed backhand punches with the affected hand.
Physical examination showed onichorrhexis and severe
brittleness of the nail of the right 2nd finger (Figure 1). The other
fingernails and the toenails were normal.
Dermoscope examination of the affected nail showed thinning
Symbiosis Group
Figure 2: Dermoscopic image of affected nail plate shows thinning,
shortening and superficial scaling.
*Corresponding author email: [email protected]
Taekwondo Nails: A Case Report and Review of the Literature on Sport-Related Nail
Abnormalities
Discussion
The most common nail abnormality described associated
with sport is the “Tennis toe”. It consists of the appearance of a
subungual hematoma generally affecting the hallux or the second
toenail whichever is longer [1, 4, 6]. The injury is incurred due
to the repeated trauma to the nail bed each time the toe contacts
the inside of the shoe, as a result of abrupt stops on the tennis
court [2-4, 6].
Subungual hematomas have also been reported in other
sports where there is constant thrusting of the athlete’s foot
into the toe box of the shoe, such as squash, soccer, basketball,
running and jogging [1, 2, 6, 8].
In runners and joggers (Jogger’s toe) the 4th and 5th toes
are more commonly affected and are accompanied by nail
discoloration, onycholysis, proximal transverse ridging and
erithema [1,2,6]. The 2nd and 3rd toes are generally affected in
soccer and squash players [6]. Other nail abnormalities reported
in soccer players include nail shedding, transverse ridging,
onycholysis and even avulsion of the nail plate, caused by the
impact force of kicking [1,2].
Professional dancers can have onychogryphosis and
subungual exostosis [2] while rhythmic gymnasts present with
lamellar splitting, splinter hemorrhages, dystrophia mediana
canaliforme, transverse (Beau’s lines), and longitudinal
pigmented bands due to trauma to the nail bed and nail matrix
[5].
Fingernail abnormalities have been reported in golfers,
Frisbee players, karate and judo fighters. The “Golfer’s nails”
refers to the distal splinter hemorrhages that appear in the
fingers used most strongly in the golf grip hand [3, 8].
Nail hemorrhage is common in Frisbee players due to the
repeated minor trauma of the nail plate originated when catching
the Frisbee [8].
Karate nails are due to the injury of the nail matrix as a
consequence of the sharp strong blows and usually present as
leukonychia [3, 9].
In Judo, trachyonychia due to the frequent grabbing of the
opponent’s jacket has been described [3, 10].
Copyright: ©
2016 de Sousa et al.
Taekwondo is a Korean martial art that means “the art of
foot and hand” [11]. Although the legs are mostly used in the
practice of taekwondo, there are some specific hand punches (the
“backfist forward strike” and the “reverse punch”) in which the
dorsal aspect of the hand is used to give the blow [7]. During these
movements, the nail plate, nail bed and nail matrix are exposed
to trauma predisposing the patient to have trauma induced nail
abnormalities.
A computerized search of Pub Med data base, as well as
GoogleScholar, was performed using the terms “sports and
nails”, “athletes and nails”, “onicopathology and sports”, “nails in
sports”, “taekwondo nails” for papers published in English from
January 1985 to the present. We were not able to find any paper
describing the above-mentioned nail signs in taekwondo.
References
1. Adams BB. Dermatologic Disorders of the Athlete. Sports Med.
2002;32(5):309-321.
2. Adams BB. Jogger’s toenail. J Am Acad Dermatol. 2003;48(5
Suppl):S58-59.
3. Baran R. Baran and Dawber’s Diseases of the Nails and Their
Management. 3rd ed 2001. London. Blackwell Science. 2008;pp.333
4. Bergfeld W, Taylor J. Trauma, Sports and the Skin. Am J Ind Med.
1985;8(4-5):403-413.
5. Biolcati G, Berlutti G, Bagarone A, CAselli G. Dermatological Marks
in Athletes of Artistic and Rhythmic Gymnastics. Int J Sports Med
2004;25(8):638-40.
6. Cohen P, Schulze K, Nelson B. Subungual Hematoma. Dermatol
Nursing. 2007;19(1):83-84.
7. Pieter F, Pieter W. Speed and Force in Selected Taekwondo Techniques.
Biol Sport. 1995;12(4):257-266
8. Ryan AM, Goldsmith
1995;131(7):857-858.
LA.
Golfer’s
Nails.
Arch
Dermatol.
9. Scher RK. Ocupational nail disorders. Dermatol Clin. 1988;6(1):27-33.
10.Shelley WB, Shelley ED. A dermatologic diary. Portrait of a practice.
Cutis. 1997;59(4):181-182.
11. Siana JE, Borum P, Kryger H. Injuries in Taekwondo. Brit J Sports Med.
1986;20(4):165-166.
Citation: de Sousa ICVD, Tosti A (2016) Taekwondo Nails: A Case Report and Review of the Literature on Sport-Related Nail
Abnormalities. Clin Res Dermatol Open Access 3(3): 1-2.
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